[The middle fossa approaches].
OBJECTIVE
Describe the surgical systematization of the different variants of the middle fossa approach.


METHODS
The search for the blue line of the superior canal at the arcuate eminence is the most reliable method to identify the internal auditory canal. When this is demonstrated, each surgical variant can then be undertaken with the surgical landmarks described below.


RESULTS
The classical suprapetrosal approach allows one to directly control the entire internal acoustic meatus from the fundus of the canal to the porus. Enlarged, it provides access to the cerebello pontine angle nearby to the porus. Finally, the petrous apex can be approached while preserving the bony labyrinth via the transpetrosal middle fossa approach.


CONCLUSIONS
Difficult to learn, the middle fossa approach depends on recognizing the surgical landmarks of the anterosuperior surface of the petrous bone. Extradural, preserving the bony labyrinth, and controlling the entire internal acoustic meatus, it is an important approach in skull base surgery.
Vincent
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C
Service d'otologie et d'otoneurologie, hôpital R. Salengro, rue Emile-Laine, CHRU de Lille, 59037 Lille cedex, France. cvincent@chru-lille.fr
D035301:Cranial Fossa, Middle; D003390:Cranial Nerve Neoplasms / Q000601:surgery*; D004424:Ear Canal; D006801:Humans; D009442:Neurilemmoma / Q000601:surgery*; D019635:Neurosurgical Procedures; D010579:Petrous Bone / Q000601:surgery; D011300:Preoperative Care; D019291:Skull Base / Q000601:surgery*; D014725:Vestibular Nerve